Patient Finance Officer

Position Summary:
Patient Finance Officer is responsible for operating the end-to-end revenue cycle process, including insurance claim preparation, submission, payment tracking, denial management and AR follow-up to ensure accurate reimbursement and minimize revenue leakage across American Chiropractic Clinics (ACC Nguyen Du, ACC Ha Noi, and Vibrant Clinic). The role requires knowledge of insurance billing, payer requirements, and claims adjudication, and works closely with clinical, patient service, and finance teams to optimize revenue collection. The position is also assigned other tasks from time to time relating to billing control or analysis as needed.
Key Responsibilities:
1. Insurance Claims and Direct Billing Administration:
1.1 Indirect billing for self-reimbursement patients:
- Provide medical certificates/documents for pay-and-claim patients to submit reimbursement claims.
- Support patients with additional document requests or inquiries from insurance providers.
- Review billing charges of insurance documentation fees (if applicable) by Front Desk team to ensure compliance to SOPs
1.2 Direct billing for insured patients:
- Process claims for direct billing patients and coordinate with insurance providers for guarantee of payment (GOP).
- Verify patient insurance eligibility, coverage, pre-authorizations and direct billing benefits.
- Explain insurance benefits, direct billing procedures, claim requirements and patient financial responsibilities to patients.
- Coordinate with patients, clinical teams and insurance companies to obtain coverage confirmations, Guarantee of Payment (GOP), and required approvals.
- Ensure invoices, claim forms, medical records, and supporting documentation are complete, accurate, and compliant with insurer requirements.
- Prepare documentation to process deposit refunds for direct billing patients based on GOP.
- Prepare, review, and submit insurance claims accurately and within agreed timelines.
- Maintain accurate claim records and follow up with insurance companies on claim status, additional information requests, and claim resolution.
2. Accounts Receivable and Collections:
- Monitor outstanding insurance receivables and proactively follow up with insurance companies to ensure timely payment.
- Reconcile insurance payments against billed amounts and investigate discrepancies.
- Inform clinics and the accounting team upon receiving claim settlements/payments to ensure accurate financial recording.
- Resolve underpayments, overpayments and other payment-related issues.
- Coordinate with the Accounting team to ensure timely receipt and reconciliation of insurance payments.
- Support month-end reconciliation of insurance account receivables (AR).
- Escalate overdue or unresolved collection matters to management when appropriate.
3. Claims & Denial Management:
- Analyze rejected or denied claims to identify root causes and recommend corrective actions.
- Prepare claim corrections, resubmissions, and appeals with appropriate supporting documentation.
- Coordinate with doctors, clinical teams, Front Desk staff, and other departments to obtain information required for claim resolution.
- Maintain claim denial records and monitor timely resolution.
- Identify trends in claim denials and recommend process improvements to improve claim acceptance rates.
4. Insurance Partner & Patient Support
- Maintain professional relationships with insurance companies.
- Respond promptly and professionally to enquiries from patients, insurers or internal departments regarding insurance coverage, claims and direct billing services.
- Assist in resolving insurance-related complaints or related issues.
- Maintain up-to-date knowledge of insurance policies, products, and direct billing requirements.
- Support the implementation of new insurance partners and related operational processes.
5. Compliance and Reporting:
- Ensure billing and claims activities comply with applicable laws, direct billing contracts and internal policies.
- Maintain accurate billing records and documentation.
- Work closely with the Accounting Manager on AR reporting and month-end closing activities.
- Collaborate with internal teams to improve billing and collection processes.
- Provide additional support to the Financial Controller on finance-related tasks and ad-hoc assignments when required.